The World Health Organization (WHO) on June 30 officially granted China a malaria-free status as a token of celebration of the country's successful elimination of the disease after 70 years of efforts.

From 30 million malaria cases in the 1940s, China gradually brought down the number over the last decades to zero cases in the last four years, the WHO said.

The WHO said that China had become the first country in the Western Pacific region to eliminate the mosquito-borne disease in over three decades, after Australia, Singapore and Brunei.

"[China's] success was hard-earned and came only after decades of targeted and sustained action," Tedros Adhanom Ghebreyesus, Director General of the WHO, said in a statement.

"With this announcement, China joins the growing number of countries that are showing the world that a malaria-free future is a viable goal," he said.

A long journey

China was once a prominent malaria-endemic country, reporting 30 million cases a year during the 1940s. Since then, eradication efforts have driven down case numbers.

In 1955, China launched the National Malaria Control Program, engaging communities to prevent the breeding of mosquitoes and transmission of the disease.

In 1967, the Chinese Government launched a nationwide research program aimed at finding new treatments for malaria. This program, involving more than 500 scientists from 60 institutions, led to the discovery in the 1970s of artemisinin - the core compound of artemisinin-based combination therapies - one of the most effective antimalarial drugs available today.

The breakthrough was made by Chinese pharmacologist Tu Youyou. The discovery has significantly reduced the mortality rates for patients suffering from malaria and helped save hundreds of lives globally, and won Tu a Nobel Prize in 2015.

Apart from finding a cure, China was one of the first countries in the world to extensively test the use of insecticide-treated bed nets (ITNs) to prevent malaria. By 1988, more than 2.4 million nets had been distributed nationwide. The use of such nets led to substantial reductions in the incidence of malaria in the areas where they were deployed.

The WHO later recommended the ITNs for malaria control in other countries. The use of these affordable and easy-to-use nets substantially reduced the cases of malaria.

By the end of 1990, the number of malaria cases in China had plummeted to 117,000, and deaths were reduced by 95 percent, according to the WHO.

Beginning in 2003, with support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, China stepped up training, staffing, laboratory equipment, medicines and mosquito control, an effort that led to a further reduction in cases. Within 10 years, the number of cases had fallen to about 5,000 annually.

No cases were reported in China in the last four years, warranting the malaria-free credential by the WHO.

Keys to success

Referring to key elements behind China's success in achieving malaria elimination, Ren Minghui, Assistant Director General for Universal Health Coverage/Communicable and Non-Communicable Diseases of the WHO, said that it is a demonstration of strong political commitment and strengthening of national health systems over decades by the Chinese Government.

An outstanding example demonstrating China's strong action is the "1-3-7 Strategy," which refers to reporting malaria cases within one day, their confirmation and investigation within three days, and the appropriate public health response to prevent further transmission within seven days. China created and rolled out the highly effective surveillance strategy in 2012.

The implementation basis of the strategy is China's established professional national-, provincial-, municipal- and county-level disease prevention and control system. This network is an effective tool to track and prevent onward transmission of the disease, and is still used nowadays for travelers coming from malaria-infected countries.

Pedro Alonso, Director of the WHO Global Malaria Program, believed part of the success in eliminating such a deadly disease was not only China's long-term vision but also its forward-thinking.

"This was a long-term plan, a long-term decision by the Chinese Government, six or seven decades ago to eliminate malaria when malaria was a major cause of disease, death and poverty," Pedro said. He added that China started launching campaigns that involved a whole-government approach, not just the health sector.

Action in Africa

According to the latest World Malaria Report released by the WHO on November 30, 2020, there were 229 million cases of malaria in 2019 compared to 228 million cases in 2018.

The report revealed that Africa continues to carry a disproportionately high share of the global malaria burden. In 2019, the region was home to 94 percent of all malaria cases and deaths.

China and Africa have boosted the joint fight against malaria through the years. China has helped African countries re-energize the war against malaria through biomedical research, training of health workers and provision of cheaper drugs.

Africa has benefitted from the "1-3-7 Strategy" that China implemented successfully. China helped Tanzania implement the strategy from 2016 to 2018, resulting in an 80-percent reduction in malaria cases in a high burden district, according to Matshidiso Moeti, WHO Regional Director for Africa. Now, the Chinese model of fighting malaria is also being implemented in three other African countries including Burkina Faso, Senegal and Zambia.

African countries are keen on harnessing Traditional Chinese Medicine to combat malaria. Fouad Mohadji, former Vice President of Indian Ocean Island of Comoros, said that African countries have tapped into China's advanced knowledge in alternative and complementary medicine to re-invigorate malaria control and treatment programs.

"The continent should adopt alternative therapies from China that are cheaper yet have proved to be effective in treating malaria," Mohadji said.

Comoros was declared malaria-free several years ago thanks to robust cooperation with China in a host of interventions aimed at containing the tropical disease.

Mohadji said Sino-Africa cooperation in research and development of new drugs will fast-track progress toward elimination of malaria in the continent.

Besides, African health experts have benefitted from training provided by China to boost their understanding of malaria control and treatment interventions.

Before the onset of the COVID-19 pandemic, African policymakers in charge of malaria control programs used to visit China for training on how to combat the disease effectively.

"The training has always targeted custodians of malaria control in health ministries. People who make policies have been learning about the Chinese strategy of fighting malaria," said Akpaka Kalu, Team leader of Tropical and Vector-borne Diseases Program at WHO Regional Office for Africa.

Now, China-Africa cooperation on malaria fight is laying emphasis on identifying, investigating, testing and treating the disease in high burden localities. The collaboration also focuses on comprehensive malaria treatment that is integrated into Africa's public health systems to help realize sustainability.

Kalu said that the future of China-Africa cooperation in the war against malaria has bright prospects, experience and expertise. 

(Printed Edition Title:Victory Over Malaria)

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